Background: Periprosthetic fracture (PPF) is a troublesome complication as it utilizes substantial healthcare resources. Recent studies about the epidemiology of PPF after total knee arthroplasty (TKA) are still lacking, and there is limited national-level analysis focusing on the comorbid chronic conditions as risk factors of PPF. This study used national registry data from South Korea and aimed to investigate the epidemiology of PPF following TKA between 2010 and 2020 and identify which comorbidities contributed to the risk of PPF. Methods: Using Health Insurance Review and Assessment (HIRA) service data in South Korea, the incidence of PPF after TKA between 2010 and 2020 was evaluated and stratified by age and sex. Medical comorbidities were evaluated as possible risk factors for PPF using Cox regression analysis. Results: PPF occurred in 14,429 patients, accounting for 2.37% of total TKA patients. The prevalence of PPF by sex was 2.50% in women and 1.64% in men. The PPF rate was 2.82% in under 60 years, 2.25% in 60 to 69 years, 2.42% in 70 to 79 years, 2.29% in 80 to 89 years, and 2.12% in over 90 years. Among 17 analyzed comorbidities, 11 were found to be associated with PPF after TKA. Severe liver disease (hazard ratio [HR], 1.303), hemiplegia (HR, 1.244), and dementia (HR, 1.206) were the top 3 risk factors.Although osteoporosis, pulmonary disease, peptic ulcer, and diabetes showed relatively low HRs than these top 3 factors, the incidence rates were higher. Conclusions PPF occurred in 2.37% of TKA patients in South Korea from 2010 to 2020. PPF rate was higher in women. To prevent PPF after TKA, proper patient management and education should be emphasized, particularly in patients with severe liver disease, hemiplegia, and dementia.

Background: Periprosthetic fracture (PPF) is a troublesome complication as it utilizes substantial healthcare resources. Recent studies about the epidemiology of PPF after total knee arthroplasty (TKA) are still lacking, and there is limited national-level analysis focusing on the comorbid chronic conditions as risk factors of PPF. This study used national registry data from South Korea and aimed to investigate the epidemiology of PPF following TKA between 2010 and 2020 and identify which comorbidities contributed to the risk of PPF. Methods: Using Health Insurance Review and Assessment (HIRA) service data in South Korea, the incidence of PPF after TKA between 2010 and 2020 was evaluated and stratified by age and sex. Medical comorbidities were evaluated as possible risk factors for PPF using Cox regression analysis. Results: PPF occurred in 14,429 patients, accounting for 2.37% of total TKA patients. The prevalence of PPF by sex was 2.50% in women and 1.64% in men. The PPF rate was 2.82% in under 60 years, 2.25% in 60 to 69 years, 2.42% in 70 to 79 years, 2.29% in 80 to 89 years, and 2.12% in over 90 years. Among 17 analyzed comorbidities, 11 were found to be associated with PPF after TKA. Severe liver disease (hazard ratio [HR], 1.303), hemiplegia (HR, 1.244), and dementia (HR, 1.206) were the top 3 risk factors.Although osteoporosis, pulmonary disease, peptic ulcer, and diabetes showed relatively low HRs than these top 3 factors, the incidence rates were higher. Conclusions PPF occurred in 2.37% of TKA patients in South Korea from 2010 to 2020. PPF rate was higher in women. To prevent PPF after TKA, proper patient management and education should be emphasized, particularly in patients with severe liver disease, hemiplegia, and dementia.

Background: Periprosthetic fracture (PPF) is a troublesome complication as it utilizes substantial healthcare resources. Recent studies about the epidemiology of PPF after total knee arthroplasty (TKA) are still lacking, and there is limited national-level analysis focusing on the comorbid chronic conditions as risk factors of PPF. This study used national registry data from South Korea and aimed to investigate the epidemiology of PPF following TKA between 2010 and 2020 and identify which comorbidities contributed to the risk of PPF. Methods: Using Health Insurance Review and Assessment (HIRA) service data in South Korea, the incidence of PPF after TKA between 2010 and 2020 was evaluated and stratified by age and sex. Medical comorbidities were evaluated as possible risk factors for PPF using Cox regression analysis. Results: PPF occurred in 14,429 patients, accounting for 2.37% of total TKA patients. The prevalence of PPF by sex was 2.50% in women and 1.64% in men. The PPF rate was 2.82% in under 60 years, 2.25% in 60 to 69 years, 2.42% in 70 to 79 years, 2.29% in 80 to 89 years, and 2.12% in over 90 years. Among 17 analyzed comorbidities, 11 were found to be associated with PPF after TKA. Severe liver disease (hazard ratio [HR], 1.303), hemiplegia (HR, 1.244), and dementia (HR, 1.206) were the top 3 risk factors.Although osteoporosis, pulmonary disease, peptic ulcer, and diabetes showed relatively low HRs than these top 3 factors, the incidence rates were higher. Conclusions PPF occurred in 2.37% of TKA patients in South Korea from 2010 to 2020. PPF rate was higher in women. To prevent PPF after TKA, proper patient management and education should be emphasized, particularly in patients with severe liver disease, hemiplegia, and dementia.

Background: Periprosthetic fracture (PPF) is a troublesome complication as it utilizes substantial healthcare resources. Recent studies about the epidemiology of PPF after total knee arthroplasty (TKA) are still lacking, and there is limited national-level analysis focusing on the comorbid chronic conditions as risk factors of PPF. This study used national registry data from South Korea and aimed to investigate the epidemiology of PPF following TKA between 2010 and 2020 and identify which comorbidities contributed to the risk of PPF. Methods: Using Health Insurance Review and Assessment (HIRA) service data in South Korea, the incidence of PPF after TKA between 2010 and 2020 was evaluated and stratified by age and sex. Medical comorbidities were evaluated as possible risk factors for PPF using Cox regression analysis. Results: PPF occurred in 14,429 patients, accounting for 2.37% of total TKA patients. The prevalence of PPF by sex was 2.50% in women and 1.64% in men. The PPF rate was 2.82% in under 60 years, 2.25% in 60 to 69 years, 2.42% in 70 to 79 years, 2.29% in 80 to 89 years, and 2.12% in over 90 years. Among 17 analyzed comorbidities, 11 were found to be associated with PPF after TKA. Severe liver disease (hazard ratio [HR], 1.303), hemiplegia (HR, 1.244), and dementia (HR, 1.206) were the top 3 risk factors.Although osteoporosis, pulmonary disease, peptic ulcer, and diabetes showed relatively low HRs than these top 3 factors, the incidence rates were higher. Conclusions PPF occurred in 2.37% of TKA patients in South Korea from 2010 to 2020. PPF rate was higher in women. To prevent PPF after TKA, proper patient management and education should be emphasized, particularly in patients with severe liver disease, hemiplegia, and dementia.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.

Background: This study aimed to 1) assess the effect of total hip arthroplasty (THA) on coronal limb alignment, namely, the hip–knee–ankle angle (HKA), 2) identify factors that determine changes in the HKA, and 3) determine whether alignment changes influence the knee joint space width. Methods: We retrospectively evaluated 266 limbs of patients who underwent THA. Three types of prostheses with neck shaft angles (NSAs) of 132°, 135°, and 138° were used. Several radiographic parameters were measured in the preoperative and final radiographs (at least 5 years after THA). A paired t-test was used to confirm the effect of THA on HKA change.Multiple regression analysis was performed to identify radiographic parameters related to HKA changes following THA and changes in knee joint space width. Subgroup analyses were performed to reveal the effect of NSA change on the HKA change, and the proportion of total knee arthroplasty usage and changes in radiographic parameters between maintained joint space and narrowed joint space groups were compared. Results: The preoperative mean HKA was 1.4° varus and increased to 2.7° varus after THA.This change was related to changes in the NSA, lateral distal femoral angle, and femoral bowing angle. In particular, in the group with a decrease in NSA of > 5°, the preoperative mean HKA was largely changed from 1.4° varus to 4.6° varus after THA. The prostheses with NSA of 132° and 135° also led to greater varus HKA changes than those with an NSA of 138°. Narrowing of the medial knee joint space was related to changes in the varus direction of the HKA, decrease in NSA, increase in femoral offset. Conclusion A large reduction in NSA can lead to considerable varus limb alignment after THA, which can have adverse effects on the medial compartment of the ipsilateral knee.